6.

1 Need for the study

Healthy child makes healthy generation. There is a close relationship between

unhealthy children to a worsened future of the world. The children are one third of our
population and all of our future. There are about 200.6 million children belonging to 6 to 12
years globally. Among them, 40% of middle school children are in India. In Karnataka there
are about 22 million children who are going to middle schools1.

WHO health statistics in 2006 estimated that, about 1400 million people world-wide
are infested with at least one type of worm. School children have worm infestation as a
common health problem throughout the world, due to poor personal hygiene. The prevalence
rate of worm infestation is 12% in India. In India, the most common problem faced by the
children are dental caries (90%), pediculosis in girls (20.42%) and in boys (13.86%), diarrhea
(25%) and scabies (43.24%). This may be attributed to lack of personal hygiene1.

Personal hygiene should be observed throughout life for healthy living. Recognizing
hygiene habits for prevention of disease is important for children. In a child-to-child program,
child can be an excellent health messenger and health volunteer in their own community.
School children can learn easily to cultivate good habits and to mould themselves. Experts
advice that health education should be a part in school curriculum. All health issues
irrespective of their sensitivity can be inculcated in educational programs in methodological
and scientific way2.

There is a need of health education to all people. It has got preventive, promotive and
rehabilitative dimensions. The school children can be an excellent mode to transmit
information. Here the investigator hope that they can be a messengers of health to other
children, to their parents, to the family and finally to reach out the community14.

In developing countries, young children spend much of their lives in the care of their
brothers or sisters. Experts observed the need for teaching these older children to provide
better care for their siblings. The importance of child-to-child programme is thus stressed.

The child to child programme was first launched in 1978 , by the Institute of Child
Health, London3.The main focus of child-to-child programme is activity oriented method of
teaching, where emphasis is placed on the development of participatory approach of learning
and teaching. In child-to-child programme the health educator may be a primary school
teacher or a health worker. They motivate the child to help each other6.

Effective school health education is a sustainable way to promote health practices. So

Health Education Bureau of India also launched an intensive school health education project
in 1989. Where one of the approach is considered for health education was child-to-child
programme11.

Previous literature proves the effectiveness of child to child approach in various

aspects of health. The present study by the investigator keeps the main aim as to assess
whether the children have knowledge of various aspects of health which he is supposed to
practice, teach, guide and to be a role model of another child. The investigator feels that
child to child approach on personal hygiene will be an effective method in imparting
knowledge in the children regarding personal hygiene. The child to child approach of

1
personal hygiene education is based on the belief that, children not only need to keep healthy
themselves, but can often be highly influential in promoting the good health of others. Thus,
the investigator felt the need to take up the study for imparting the knowledge regarding
personal hygiene among middle school children.

6.2 Review of literature

Review of literature is a critical summary of research on a topic of interest.

In this study the literature reviewed has been organized under the following headings.

1) Literature related to child-to-child approach.

2) Literature related to personal hygiene.
3) Literature related to Child-to-Child approach on personal hygiene.

1. Literature related to child-to-child approach.

A study was conducted in Mumbai on the utilization of child to child concept during
pulse polio immunization in 2004, among families in urban slums. In this study 50 children
in the age group of 10 to 12 years were trained on the different aspects of Pulse Polio
Immunization. Each child was allocated 30 families to whom they explained about pulse
polio immunization and its importance prior to the due dates of Pulse Polio Immunization .
The study showed that all the eligible children from the selected 150 families was
immunized, achieving a 100% response for immunization among the children covered by
child to child group.5

A Child to child programme was conducted by department of preventive oncology in

2004, among urban slums of Mumbai, regarding awareness of tuberculosis. 65 students of
age 10 to 12 years were used to spread the message. One hour sessions were conducted
regularly, once a week for 17 weeks, on tuberculosis and its management. With the help of
these school children, 54 patients were referred to the hospital. Many of them had
bronchitis, pneumonia and upper respiratory tract infections. 3 cases of tuberculosis were
detected among the referred cases.5

An experimental study was conducted in Belgham, to assess the impact of child to

child programme on knowledge, attitude and practice regarding diarrhoea among rural
school children. They conducted the study on 54 students of one school as experimental
group and 54 students of another school as control group. 12 health talk sessions were
conducted for the experimental group. Pretest mean score was 1.44 and post test mean was
23.57 for the study group whereas pre test mean was 4.04 and post test mean was 3.20 in
control group.7

A pretest- post test study was conducted at a selected school of Chennai ,to know the
effectiveness of a planned health education through child-to-child activities on knowledge of
vitamin B12. 133 peer group members and 19 peer leaders were selected from 7th Standard for
the study. The research design was pretest- post test design. . The study revealed that the
child-to-child approach is effective, which was found to be significant at P<0.001 level. The
knowledge scores of the pre test was 16% and after training the peer leaders to give health
education to remaining peer group members, the post test score were 54.9.4

2. Literature related to personal hygiene:

2
 A study was conducted in Maharashtra in 2007, to find out the prevalence of
intestinal parasites among rural Indian school going children(6-14 years) and the effect of
focused, need based child to child hygiene education on personal hygiene of school
children. A triangulated research design was used in the study for need assessment before
initiating formal hygiene education.118 children were examined under the study. Out of
the 118 children who were examine , 21(25.9%) had intestinal parasite infection. Among
the 118 children, 88 (74.6%) were not using sanitary latrines, 38(32.2%) were with
unhygienic untrimmed nails and 30(25.4%) were not using foot wear. The prevalence of
parasitic infection was significantly high among children having dirty untrimmed nails
( OR=23.1; 95% CI: 5.6-110.4) followed by those having poor hand washing
practices(OR = 8.3;95% CI: 2.5-29.1).2

In the 2nd phase of the study 4 willing students (10-14 years) were selected for
dissemination of information regarding personal hygiene. Under supervision, students
disseminated messages and demonstrated hand washing and nail cutting in each class of
target children. The Post test, which was conducted after 1 month ,showed significant
improvement in the key personal hygiene behavior( p< 0.05). The proportion of children
having practice of hand washing with soap after defecation significantly improved from
75(63.6%) to 92(78%). The proportion of clean and cut nails also improved from
80(67.8%) to 95(80%).2

3. Literature related to child to child approach on personal hygiene.

A Quasi experimental study was conducted among orphans and vulnerable children in
promoting positive hygiene behaviors in rural western Kenya in 2008 using child-to-child
approach. The study was carried out among 300 children. The study proved that, there was
significant improvement in knowledge, attitude and practice among the orphan and
vulnerable children after the health teaching was given using child to child approach.6

A Quasi experimental study was conducted to assess the effectiveness of child-to-child

activities in prevention of worm infestation in school children in Bangalore. The sample size
was 238. They were motivated to spread the health information to the remaining children at
school. After one week, a post test was given to 238 children who were selected earlier. The
scores was effective to increase the knowledge of children regarding worm infestation.8

An experimental study was conducted in China, regarding effectiveness of a school

based oral health education programme.The study was implemented in 6 schools; children in
3 schools were taken as experimental group and those in remaining 3 schools were taken as
the control group. The revealed that the children in experimental group adopted regular oral
health behavior compared to the control group.16

6.3 Problem Statement

3
 A comparative study to assess the effectiveness of child-to-child approach in
teaching personal hygiene among selected rural and urban middle school children,
Bangalore.

6.4 Objectives of the study

1. To assess the pretest knowledge of the children in selected rural and urban middle
school regarding personal hygiene.
2. To assess the post test knowledge of the children in selected rural and urban middle
school regarding personal hygiene.
3. To assess the effectiveness of child-to-child approach in teaching personal hygiene
among rural and urban middle school children.
4. To compare the knowledge of both urban and rural children regarding personal
hygiene.

6.5 Operational Definitions

Child-to-child approach
In this study it refers to health information and knowledge which are imparted
to one child, is transmitted to another child, may be to a younger child, sibling or
peer group which is measured by using a structured questionnaire.

Effectiveness
In this study it refers to the extent to which the child -to- child approach in
teaching personal hygiene leads to the gain in knowledge which will be measured by
mean difference in pretest and post test score.

Middle school children

In this study it refers to the children who are studying in 5 th to 7th standard of
selected urban and rural schools in the age group of 10 to 14 years.

Personal hygiene
In this study refers taking care of and maintaining a clean, odor free, sanitary
body, including hair and nail.

6.6. Assumption

The study assumes that

1. The rural children interact more often than the urban children thus transmit more
information.
2. Children are able to transmit information among themselves. (Peer group influence).

6.7. Delimitations

1. Middle school children studying in selected urban and rural schools of Bangalore.

6.8 Hypothesis

4
 H1: There will be a significant difference in mean pre test and post test knowledge score
in rural middle school children at 0.05 level of significance.
H2: There will be a significant difference in mean pre test and post test knowledge score
in urban middle school children at 0.05 level of significance.
H3: There is will be a significant difference in knowledge between the rural and urban
middle school children at 0.05 level of significance

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

7.1.1 Research Design

A comparative quasi experimental study design will be used to achieve the objectives of
the study.

7.1.2 Setting

The setting selected for the study is Thirupallya Government school and Jakasandra
Government school. Thirupallya Government school is under Hebagoodi PHC, which is a
high school consisting of 107 children in 5th to 7th standard. Jakasandra school is situated
near Madiwala , which is also a high school consisting of 86 children in 5th to 7th standard.

7.1.3 Population

In this study the population comprises of 5 th, 6th, and 7th standard children in selected
rural and urban middle school, Bangalore

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling procedure

Convenient Sampling technique will be used in this study.

7.2.2 Sampling Size

The sample size will be 193 school children. 107 children from Thirupallaya rural
school and 86 children from Jakasandra urban middle school.

7.2.3 Inclusion criteria for sampling

children studying in 5th, 6th, 7th Standards only in selected urban and rural school,
Bangalore.

7.2.4 Exclusion Criteria for sampling

Who are absent and not willing to study.

7.2.5 Instrument Used

5
 Section 1. Performa to elicit baseline data of children.
Section 2. Structured questionnaire to assess the knowledge of children regarding
personal hygiene.
Section 3. Structured teaching programme on personal hygiene.

7.2.6 Data Collection Method

Formal permission will be obtained from the BEO of both urban and rural areas.
Headmasters of both the school will be informed and explained about the study and the
formal permission will be seeked. Then the investigator will list the name of the students of
5th, 6th, 7th classes by using the attendance register maintained in the schools. From each of
these classes 3 students will be randomly selected by the investigator. These 9 children from
each of the school will be thought on personal hygiene for about 30 minutes by using Audio
Visual aids on two different days by the investigator. The other students in the class will be
administered a pretest before the teaching could take place. After the teaching the students
will be allowed to transmit the information to the students in their respective classes. After 7
days a post test will be conducted.

7.2.7 Data analysis plan

1 . Organization of data in master sheet.

The baseline variables will be assessed by using descriptive statistics studies mean ,
percentage and standard deviation.

2 . Inferential statistics such as chi-square and t test will be done to assess the effectiveness of
child-to-child approach in teaching, also to compare the knowledge of urban and rural school
children

7.3 Does the study requires any investigation or intervention to be conducted on patients
or other humans or animals? If so, please describe briefly.

Nil

7.4 Has ethical clearance been obtained from your institution?

Administrative and ethical clearance with regard to the study has obtained from the
research committee.

LIST OF REFERENCES

6
 1. Sharma M, Sankalp. Indian little doctors leading the way in good hygiene. Indian
Journal of community medicine:2008.47(3) Nov-Dec:24-8
2. Dongre AR, Garg BS. A approach to hygiene education among rural Indian school
going children. Journal of health and allied siences: 2007:6(4) Oct-Dec:32-6
3. Dong AR, Deshmukh PR Garg BS. The impact of school health education programme
on personal hygiene and related morbidities in tribal school children of Wardha
district. Indian community medicine: 2006; 31(1):81-82.
4. Sharma. Child- to -child hygiene education. Journal of health:2005:4(2) Feb-Apr:25-8
5. Mishra G. When child becomes a teacher the child -to -child programme. Indian
journal of community medicine.2006;31(4) Oct- Dec:227-8.
6. Reichal TC. Using the chilid to child approach in promoting positive hygiene
behaviors among orphans and vulnerable children in rural western Kenya.2008
WFPHA/APHA.
7. Walvekar PR, Naik VA. Impact of child to child programme on knowledge, attitude,
practice regarding diarrhoea among rural school children. Indian Journal of
community medicine: 2006:31(2)Apr-Jun:56-9.
8. Divya Lata. Organizations wishing to incorporate the child-to-child approach in their
programs require training inactivity based learning methods :2008 .Apr:1-3
9. Aga khan. Child to-child A resource book implementing and activity.[Online]. 1996.
[cited2000]. Available from: URL: http//www.child-to-child.org/blurit.com.htm.
10. World Health Report 2006.Avilable from: URL:http//www.world health report.html.
11. UNICEF. Child-to-child practice: Getting ready for school project.[Online].2009
[cited2010].Available from:URL: http//www.child-to-child.org/ action/getting ready
for school.htm.
12. Global Action Week. Child-to-child survey.[Online].2003[cited2004].Available
from:URL:http//www.unicef.org/education/campaign-child-to-childsurvey.html.
13. Marginales. Child-to-child readers and training packs.[Online].1990[cited2007].
Available from: URL: http//www.blurit.com/q1882661.htm.
14. Park K. Text book of preventive and social medicine. 20th ed. Jabalpur .Banarsidas
publishers; 2009:34
15. Polit DF, Beck CT . Nursing Research: generating and assessing evidence for nursing
practice. 8th ed. Philadelphia. Lippioncott Williams and Wilkins pb; 2004:323-6.
16. Lebanon. Child-to-child approaches to childrens participation in health and
development: A course for programmers and facilitators. [Online]. 2010. Available
from : copyright@2009 child-to-child; [2010 oct 11-6]

8 SIGNATURE OF THE STUDENT

7
9 REMARKS OF THE GUIDE

10 NAME AND DESIGNATION OF

10.1 GUIDE MRS.MERCY P.J
PROFESSOR AND HEAD OF THE
DEPARTMENT
COMMUNITY HEALTH NURSING,
ST.JOHNS COLLEGE OF NURSING

10.2 SIGNATURE

10.3 CO-GUIDE(IF ANY) DR.SULEKHA,ASSOCIATE

PROFESSOR,DEPARTMENT OF
COMMUNITY MEDICINE,
ST.JOHNS NATIONAL ACADEMY OF
HEALTH SCIENCES
BANGALORE.

10.4 SIGNATURE

11 11.1 HEAD OF DEPARTMENT MRS.MERCY P.J

PROFESSOR AND HEAD OF THE
DEPARTMENT
ST.JOHNS COLLEGE OF NURSING
BANGALORE.

11.2 SIGNATURE

12 12.1 REMARKS OF THE

CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE